Method and devices for performing minimally invasive surgery

ABSTRACT

A device for use in performing minimally invasive surgery. A system for performing minimally invasive surgery comprising the device according to the present invention. A method for performing minimally invasive surgery.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present Application claims the benefit of U.S. Provisional PatentApplication 61/179,301, titled “Method and Devices for PerformingMinimally Invasive Surgery,” filed May 18, 2009, and claims the benefitof U.S. Provisional Patent Application 61/230,944, titled “Method andDevices for Performing Minimally Invasive Surgery,” filed Aug. 3, 2009,and claims the benefit of U.S. Provisional Patent Application61/240,406, titled “Method and Devices for Performing Minimally InvasiveSurgery,” filed Sep. 8, 2009, the contents of which are incorporated inthis disclosure by reference in their entirety.

BACKGROUND

Abdominal surgery is used to treat a variety of diseases and conditions.Techniques for performing abdominal surgery have made major advancesduring the past 150 years. Originally, surgeons made incisions in theabdominal wall sufficiently large to allow the surgeon to insert bothhands into the abdominal cavity to gain easy access to the abdominalorgans and to examine the abdominal organs by touch. This surgicalmethod is referred to as “open surgery.”

During the 1980's and 1990's, a new form of surgery called “laparoscopicsurgery” (standard laparoscopic surgery) was developed that requiredseveral smaller incisions of between 5 mm and 20 mm each to create portsfor the placement of specialized instruments into the abdominal cavity.Recovery from laparoscopic surgery generally requires less time, is lesspainful and has fewer complications associated with abdominal wallincisions than does open surgery.

Several forms of laparoscopic surgery have been developed, including“laparoendoscopic single-site surgery” (LESS), where a single incisionbetween 20 mm and 50 mm is made in the crease of the umbilicus and allinstruments are introduced into the abdominal cavity through the oneincision. The resultant cosmesis is improved in laparoendoscopicsingle-site surgery (LESS) compared with other forms of laparoscopicsurgery because the single scar from laparoendoscopic single-sitesurgery (LESS) is concealed in the umbilicus, although the singleincision is longer in length compared to other forms of laparoscopicsurgery. Performing laparoendoscopic single-site surgery (LESS),however, is technically more difficult for the surgeon than other formsof laparoscopic surgery because the surgeon loses the mechanicaladvantage of triangulating several instruments from different anglesthat is available with standard laparoscopic surgery.

Another form of laparoscopic surgery called “natural orificetransluminal endoscopic surgery” (NOTES) has been developed where someof the laparoscopic instruments are introduced into the abdominal cavitythrough natural orifices (the mouth, urethra, anus and vagina), therebyhiding the resultant surgical access scars inside the body. Naturalorifice transluminal endoscopic surgery, however, is technically moredifficult to perform than standard laparoscopy in both sexes, and ismore difficult to perform in men than women because men lack a vaginalcanal and thus lack that source of access into the abdominal cavity.

Another form of laparoscopic surgery called “needlescopic surgery” usesdevices introduced through ports using 2 mm and 3 mm openings in theabdominal wall. Two millimeter ports leave no visible scar. Threemillimeter ports leave small visible scars that are difficult to seeeven by trained medical personnel. The major limitation on thedevelopment of the needlescopic surgery has been the poor functionalityof the instruments that fit through the very small ports. Further,instruments that fit through 2 mm ports generally have shafts that aretoo short to be used in adult sized patients. Additionally, someabdominal procedures require instruments that need larger ports than 3mm for placement in the abdominal cavity. Because of these limitations,needlescopic surgery has not gained popularity despite potentialadvantages for cosmesis and patient recovery.

Therefore, there is a need for a new surgical procedure that combinesthe broad usefulness of standard laparoscopic surgery with its multipleincisions that allow triangulation of instrumentation, but with theimproved cosmesis of laparoendoscopic single-site surgery, naturalorifice transluminal endoscopic surgery and needlescopic surgery.

SUMMARY

According to one embodiment of the present invention, there is provideda device for use in performing minimally invasive surgery. The devicecomprises a user interface comprising: a) a proximal portion, anintermediate portion and a distal portion, where the intermediateportion connects the proximal portion to the distal portion; and b) apushrod, a shaft and a spring; where the distal portion is configured toreversibly mate with a working end; where the proximal portion isconfigured to allow a user to hold and direct the user interface, and tooperate the working end attached to the distal portion of the userinterface; where the proximal portion of the user interface comprises aproximal handle and a distal handle joined together by and rotatablearound a pivot; where the pushrod comprises a proximal portion of thepushrod and a distal portion of the pushrod; where the proximal portionof the pushrod comprises a proximal end of the proximal portion of thepushrod, and comprises a distal end of the proximal portion of thepushrod; where the proximal end of the proximal portion of the pushrodis linked to the proximal handle, such that movement of the proximalhandle around the pivot translates into axial movement of the pushrod;where the distal portion of the pushrod comprises a proximal end of thedistal portion of the pushrod, and comprises a distal end of the distalportion of the pushrod; where the distal end of the proximal portion ofthe pushrod is joined to the proximal end of the distal portion of thepushrod at a junction; where the distal end of the distal portion of thepushrod comprises an expansion for mating with the working end; wherethe shaft comprises a hollow tubular structure comprising a longitudinalaxis and further comprises a proximal portion of the shaft and a distalportion of the shaft; where the shaft surrounds at least part of thedistal portion of the pushrod; where the distal portion of the pushrodis axially slidable within the shaft; and where the spring surrounds theproximal end of the distal portion of the pushrod, and the spring isbetween and abuts the distal end of the proximal portion of the pushrodand the proximal portion of the shaft. In one embodiment, the userinterface further comprises a shaft securing pin configured to insertwithin a recess in the distal handle, thereby securing the shaft frommoving relative to the distal handle. In another embodiment, the devicefurther comprises a working end for performing a function duringminimally invasive surgery, where the working end is configured toreversibly mate with the distal end of the distal portion of the userinterface. In another embodiment, the function is selected from thegroup consisting of canulating, clip application, cutting, grasping,lighting, recording images, retracting, sealing, suctioning, and viewingimages.

According to another embodiment of the present invention, there isprovided a device for use in performing minimally invasive surgery. Thedevice comprises a working end for mating with a user interface. Theworking end has a grasping function, and the working end comprises: a) ahead piece comprising a proximal portion of the head piece connected toa distal portion of the head piece; b) a jaw pushrod comprising aproximal portion of the jaw pushrod and a distal end of the jaw pushrod;c) a first jaw and a second jaw connected to the distal end of the jawpushrod by a jaw pivot; and d) a shaft clamp and one or more than oneshaft clamp pins for aligning the shaft clamp with the proximal portionof the head piece; where the distal portion of the head piece isconnected to the proximal portion of the jaw pushrod by a jaw pin; wherethe first jaw and the second jaw approximate and separate from eachother in response to axial movement of the jaw pushrod; where theproximal portion of the head piece comprises a recess for mating withthe distal portion of the shaft and the distal end of the jaw pushrod;and where the distal portion of the shaft and the distal end of the jawpushrod are secured to the head piece by placing the shaft clamp ontothe proximal portion of the head piece and securing the shaft clamp ontothe proximal portion of the head piece by threading a threaded fastenerover both the shaft clamp and the proximal portion of the head piece.

According to another embodiment of the present invention, there isprovided a device for use in performing minimally invasive surgery. Thedevice comprises a working end for mating with a user interface. Theworking end has a cutting function and the working end comprises: a) ahead piece comprising a proximal portion of the head piece connected toa distal portion of the head piece; b) a blade pushrod comprising aproximal portion of the blade pushrod and a distal end of the bladepushrod; c) a first blade and a second blade connected to the distal endof the blade pushrod by a blade pivot; and d) a shaft clamp and one ormore than one shaft clamp pins for aligning the shaft clamp with theproximal portion of the head piece; where the distal portion of the headpiece is connected to the proximal portion of the blade pushrod by ablade pin; where the first blade and the second blade approximate andseparate from each other in response to axial movement of the bladepushrod; where the proximal portion of the head piece comprises a recessfor mating with the distal portion of the shaft and the distal end ofthe blade pushrod; and where the distal portion of the shaft and thedistal end of the blade pushrod are secured to the head piece by placingthe shaft clamp onto the proximal portion of the head piece and securingthe shaft clamp onto the proximal portion of the head piece by threadinga threaded fastener over both the shaft clamp and the proximal portionof the head piece.

According to another embodiment of the present invention, there isprovided a device for performing a suction function during minimallyinvasive surgery. The device comprises a suction connector proximally, asuction head distally and a suction shaft connecting the suctionconnector to the suction head; where the suction connector comprises ajoining piece comprising a proximal end of the joining piece and adistal end of the joining piece, and further comprises a central cavitywithin the joining piece between the proximal end of the joining pieceand the distal end of the joining piece; where the suction connectorfurther comprises a circlip for clamping a source of suction insertedthrough the proximal end of the joining piece and into central cavityonto the joining piece; where the suction shaft comprises a hollowtubular structure comprising a proximal end of the suction shaft, adistal end of the suction shaft, an intermediate section of the suctionshaft connecting the proximal end of the suction shaft to the distal endof the suction shaft, an inner surface of the suction shaft, an outersurface of the suction shaft, a wall of the suction shaft definedbetween the inner surface of the suction shaft and the outer surface ofthe suction shaft, a central lumen of the suction shaft defined by theinner surface of the suction shaft, an outer transverse diameter definedby the outer surface of the suction shaft and an inner transversediameter defined by the inner surface of the suction shaft; where thesuction head comprises from proximal to distal a fastener, a shaftclamp, a shaft clamp o-ring, a clamp funnel, a clamp funnel o-ring and asuction tip; where the distal end of the suction shaft passes within thefastener, the shaft clamp, the shaft clamp o-ring, the clamp funnel, andthe clamp funnel o-ring and is fixed in position, allowing suction froma source of suction to be delivered to the suction tip, and externallythere through; and where the outer transverse diameter of the suctionshaft is between 1 mm and 3 mm. In one embodiment, the device furthercomprises a fine mesh covering the suction tip.

According to another embodiment of the present invention, there isprovided a device for performing minimally invasive surgery, where thedevice is an electrocautery assembly for performing electrocautery. Theelectrocautery assembly comprises: a) an electrocautery assembly shaftproximally configured to reversibly mate with an electrocautery assemblyhead distally; where the electrocautery assembly shaft comprises acylindrical structure comprising a proximal end of the electrocauteryassembly shaft, a distal end of the electrocautery assembly shaft, anintermediate section of the electrocautery assembly shaft connecting theproximal end of the electrocautery assembly shaft to the distal end ofthe electrocautery assembly shaft; b) a central core extending from theproximal end of the electrocautery assembly shaft to the distal end ofthe electrocautery assembly shaft and an insulation casing surroundingthe central core in the intermediate section, where the insulationcasing comprises an outer surface of the insulation casing; where theelectrocautery assembly shaft further comprises an outer transversediameter defined by the outer surface of the electrocautery assemblyshaft; where the central core comprises material suitable fortransmitting an electric charge from the proximal end of theelectrocautery assembly shaft to the distal end of the electrocauteryassembly shaft; where the insulation casing of the electrocauteryassembly shaft comprises material suitable to insulate any electriccharge in the central core from the external environment; and where theelectrocautery assembly head comprises a proximal end of theelectrocautery assembly head, and a distal end of the electrocauteryassembly head, and comprises from the proximal end of the electrocauteryassembly head to the distal end of the electrocautery assembly head, aproximal section of the electrocautery assembly head connected to anintermediate section of the electrocautery assembly head connected to adistal section of the electrocautery assembly head; where theelectrocautery assembly head further comprises an insulation casing ofthe electrocautery assembly head and a central core of theelectrocautery assembly head; where the insulation casing of theelectrocautery assembly head surrounds the core in the proximal sectionof the electrocautery assembly head and the intermediate section of theelectrocautery assembly head; where the distal section of theelectrocautery assembly head comprises the core of the electrocauteryassembly head; where the proximal section of the electrocautery assemblyhead is a hollow tubular structure defined by the insulation casing andis configured to mate with the distal end of the electrocautery assemblyshaft; where the distal end of the electrocautery assembly shaft fitsinto a matching recess in the intermediate section of the electrocauteryassembly head, thereby making electrical contact with the core of theelectrocautery assembly head; where the core comprises material suitablefor transmitting an electric charge from the distal end of theelectrocautery assembly shaft to the distal end of the electrocauteryassembly head, and there through to living tissue; where the insulationcasing of the electrocautery assembly head comprises material suitableto insulate any electric charge in the core from the externalenvironment; where the distal end of the electrocautery assembly shaftis configured to mate with the proximal section of the electrocauteryassembly head; and where the outer transverse diameter of theelectrocautery assembly shaft is between 1 mm and 3 mm.

According to another embodiment of the present invention, there isprovided a system for performing minimally invasive surgery, where thesystem comprises one or more than one device according to the presentinvention. In one embodiment, the system further comprises written orrecorded directions for using the one or more than one device. In oneembodiment, the system comprises two devices according to the presentinvention.

According to another embodiment of the present invention, there isprovided a method for performing a form of minimally invasive surgery,referred to as “scarless microport augmented restoration oftriangulation surgery” (SMART surgery), in a body cavity within a livingbody, where the body cavity is separated from a space outside of thebody by a body wall. The method comprises: a) providing a first devicecomprising a first part and a second part; b) making two or more thantwo openings into the body wall, where the two or more than two openingscomprise a first opening and a second opening; where the first openinghas a maximum transverse dimension that permits introduction of thefirst part of the first device from the space outside of the bodythrough the first opening and into the body cavity, where the first partof the first device has a maximum external transverse dimension greaterthan 3 mm; where the second opening has a maximum transverse dimensionbetween 0.1 mm and 3 mm and permits introduction of a second part of thefirst device from the space outside of the body through the secondopening and into the body cavity, where the second part of the firstdevice has a maximum external transverse dimension of between 0.1 mm and3 mm; c) introducing the second part of the first device from the spaceoutside of the body through the second opening into the body cavity; d)passing the second part of the first device from inside of the bodycavity through the first opening into the space outside of the body; e)coupling the first part of the first device to the second part of thefirst device in the space outside of the body to make an assembled firstdevice; f) passing the first part of the first device coupled to thesecond part of the first device back into the body cavity through thefirst opening; and g) using the first device to perform a procedurewithin the body cavity. In one embodiment, the method further comprises:a) introducing a second device into the body cavity through the firstopening; and b) using the first device and the second device to performa procedure within the body cavity allowing for triangulation of thefirst device with respect to the second device. In another embodiment,the method further comprises: a) providing a second device comprising afirst part and a second part; b) making a third opening through the bodywall and into the body cavity, and where the third opening has a maximumtransverse dimension between 0.1 mm and 3 mm and permits introduction ofthe second part of the second device from the space outside of the bodythrough the third opening and into the body cavity; c) introducing thesecond part of the second device from the space outside of the bodythrough the third opening into the body cavity; d) passing the secondpart of the second device from inside of the body cavity through thefirst opening into the space outside of the body; e) coupling the firstpart of the second device to the second part of the second device in thespace outside of the body to make an assembled second device; f) passingthe first part of the second device coupled to the second part of thesecond device back into the body cavity through the first opening; g)using the second device to perform a procedure within the body cavity.In one embodiment, the method further comprises: a) introducing a thirddevice into the body cavity through the first opening; and b) using thefirst device, the second device and the third device to perform aprocedure within the body cavity allowing for triangulation of the firstdevice with respect to the second device and with respect to the thirddevice. In one embodiment, the method further comprises introducing afirst port into the first opening, where the first port extends from thespace outside of the body through the body wall and into the bodycavity, where the first port has a maximum transverse dimension thatpermits introduction of the first part of a first device from a spaceoutside of the body through the first port and into the body cavity, andwhere the first part of the first device has a maximum externaltransverse dimension greater than 3 mm. In another embodiment, themethod further comprises introducing a second port into the secondopening, where the second port extends from the space outside of thebody through the body wall and into the body cavity, and where thesecond port has a maximum transverse dimension between 0.1 mm and 3 mmthat permits introduction of a second part of the first device from aspace outside of the body through the second opening and into the bodycavity. In another embodiment, the method further comprises introducinga third port into the third opening, where the third port extends fromthe space outside of the body through the body wall and into the bodycavity, and where the third port has a maximum transverse dimensionbetween 0.1 mm and 3 mm that permits introduction of a second part ofthe second device from a space outside of the body through the thirdopening and into the body cavity. In another embodiment, the methodfurther comprises passing the first part of the first device and secondpart of the first device from the body cavity back through the firstopening and into the space outside of the body, uncoupling and removingthe first part of the first device from the second part of the firstdevice. In another embodiment, the method further comprises passing thesecond part of the first device back through the first opening and intothe body cavity, and then back through the second opening therebyremoving the first part of the first device from the body. In anotherembodiment, the first part of the first device is a first, first part ofthe first device, and the method further comprises coupling a second,first part of the first device to the second part of the first device inthe space outside of the body to make a second, first device, passingthe second, first part of the first device coupled to the second part ofthe first device back into the body cavity through the first opening andusing the second, first device to perform a procedure within the bodycavity.

FIGURES

These and other features, aspects and advantages of the presentinvention will become better understood with regard to the followingdescription, appended claims, and accompanying figures where:

FIG. 1 is a partial, lateral perspective view of a user interfaceaccording to the present invention;

FIG. 2 is a partial, top perspective view of the user interfaceaccording to the present invention as shown in FIG. 1;

FIG. 3 is a cutaway, partial, lateral perspective view of the proximalend of the user interface according to the present invention as shown inFIG. 1 and FIG. 2 taken along the line 3-3;

FIG. 4 is a close-up, partial, lateral perspective view of a grasperworking end reversibly attached to the distal end of the user interfacewith the grasper in the open position;

FIG. 5 is a close-up, partial, lateral perspective view of a grasperworking end reversibly attached to the distal end of the user interfacewith the grasper in the closed position;

FIG. 6 is an exploded, close-up, partial, lateral perspective view of agrasper working end and the distal end of the user interface as shown inFIG. 4;

FIG. 7 is a cutaway, close-up, partial, lateral perspective view of agrasper working end reversibly attached to the distal end of the userinterface with the grasper in the open position as shown in FIG. 4 takenalong the line 7-7;

FIG. 8 is a cutaway, close-up, partial, lateral perspective view of acutting working end according to the present invention reversiblyattached to the distal end of the user interface with the cuttingworking end in the open position;

FIG. 9 is a partial, frontal-lateral perspective view of a suctiondevice according to the present invention;

FIG. 10 is lateral perspective view of the suction device as shown inFIG. 9;

FIG. 11 is a cross-sectional, lateral perspective view of the suctiondevice as shown in FIG. 9 taken along the line 11-11;

FIG. 12 is an exploded, frontal-lateral perspective view of the distalend of the suction device shown in FIG. 9;

FIG. 13 is a partial, frontal-lateral perspective view of anelectrocautery assembly according to the present invention;

FIG. 14 is a partial, lateral perspective view of the distal end of theelectrocautery assembly according to the present invention as shown inFIG. 13;

FIG. 15 is a cutaway, partial, lateral perspective view of the distalend of the electrocautery assembly according to the present invention asshown in FIG. 13 and FIG. 14 taken along the line 15-15; and

FIG. 16 through FIG. 32 show some steps in a method for performingminimally invasive surgery according to the present invention.

DESCRIPTION

According to one embodiment of the present invention, there is provideda device for use in performing minimally invasive surgery. According toanother embodiment of the present invention, there is provided a systemfor performing minimally invasive surgery. The system comprises one ormore than one device according to the present invention. According toanother embodiment of the present invention, there is provided a methodfor performing minimally invasive surgery. The method combines the broadusefulness of standard minimally invasive surgery with its multipleincisions that allow triangulation of instrumentation, but with theimproved cosmesis of laparoendoscopic single-site surgery, naturalorifice transluminal endoscopic surgery and needlescopic surgery. Themethod is referred to as “scarless microport augmented restoration oftriangulation surgery” (SMART surgery). In one embodiment, the methodcomprises providing a device according to the present invention orproviding a system according to the present invention. The device,system and method will now be disclosed in detail.

As used in this disclosure, except where the context requires otherwise,the term “comprise” and variations of the term, such as “comprising,”“comprises” and “comprised”are not intended to exclude other additives,components, integers or steps.

As used in this disclosure, the term “minimally invasive surgery”comprises endoscopic surgery (including laparoscopic,retroperitoneoscopic and thoracoscopic surgery, natural orifice surgery,and robotic surgery).

All dimensions specified in this disclosure are by way of example onlyand are not intended to be limiting. Further, the proportions shown inthese Figures are not necessarily to scale. As will be understood bythose with skill in the art with reference to this disclosure, theactual dimensions of any device or part of a device disclosed in thisdisclosure will be determined by the intended use.

As used in this disclosure, except where the context requires otherwise,the method steps disclosed and shown are not intended to be limiting norare they intended to indicate that each step is essential to the methodor that each step must occur in the order disclosed except as specifiedin this disclosure.

The devices of the present invention and their component parts compriseany suitable material for the intended purpose of the device, as will beunderstood by those with skill in the art with reference to thisdisclosure. For example, when the device according to the presentinvention is used in connection with the method according to the presentinvention, the device will usually comprise one or more than onebiocompatible material capable of being sterilized. Biocompatible refersto a material that can be used with living tissue without toxicity tothe living tissue in connection with the use.

According to the present invention, there is provided one or more thanone device for use in performing minimally invasive surgery, and inparticular for performing a method according to the present inventiondesignated “scarless microport augmented restoration of triangulationsurgery” (SMART surgery) in this disclosure. In one embodiment, the oneor more than one device is constructed to be sterilizable for reuse onmultiple patients. In another embodiment, the one or more than onedevice is constructed inexpensively and intended to be disposed of aftera single use on one patient. Referring now to FIG. 1, FIG. 2 and FIG. 3,there are shown, respectively, a partial, lateral perspective view of auser interface according to the present invention (FIG. 1); a partial,top perspective view of the user interface according to the presentinvention as shown in FIG. 1 (FIG. 2); and a cutaway, partial, lateralperspective view of the proximal end of the user interface according tothe present invention as shown in FIG. 1 and FIG. 2 taken along the line3-3 (FIG. 3). As can be seen, in one embodiment of the present inventionthe device is a user interface 10 comprising a proximal portion 12, anintermediate portion 14 and a distal portion 16, where the intermediateportion 14 connects the proximal portion 12 to the distal portion 16.The distal portion 16 is configured to reversibly mate with a workingend (such as the grasper working end 100 and the cutting working end 130disclosed in this disclosure). The proximal portion 12 is configured toallow a user to hold and direct the user interface 10, and to operatethe working end attached to the distal portion 16 of the user interface10 (such as the grasper working end 100 and the cutting working end 130disclosed in this disclosure).

The proximal portion 12 of the user interface 10 comprises a proximalhandle 18 and a distal handle 20 joined together by and rotatable arounda pivot 22. As shown, particularly in FIG. 3, the user interface 10further comprises a pushrod 24, a shaft 26 and a spring 28. The pushrod24 comprises a proximal portion 30 of the pushrod 24 and a distalportion 32 of the pushrod 24. The proximal portion 30 of the pushrod 24comprises a proximal end 34 of the proximal portion 30 of the pushrod24, and comprises a distal end 36 of the proximal portion 30 of thepushrod 24. The proximal end 34 of the proximal portion 30 of thepushrod 24 is linked to the proximal handle 18, such that movement ofthe proximal handle 18 around the pivot 22 translates into axialmovement of the pushrod 24. The distal portion 32 of the pushrod 24comprises a proximal end 38 of the distal portion 32 of the pushrod 24,and comprises a distal end 40 of the distal portion 32 of the pushrod24. The distal end 36 of the proximal portion 30 of the pushrod 24 isjoined to the proximal end 38 of the distal portion 32 of the pushrod 24at a junction 42. The distal end 40 of the distal portion 32 of thepushrod 24 comprises an expansion 44 for mating with a working end (suchas the grasper working end 100 and the cutting working end 130 disclosedin this disclosure).

The shaft 26 comprises a hollow tubular structure comprising alongitudinal axis and further comprising a proximal portion 46 of theshaft 26 and a distal portion 48 of the shaft 26, where the shaft 26surrounds at least part of the distal portion 32 of the pushrod 24,where the distal portion 32 of the pushrod 24 is axially slidable withinthe shaft 26. In one embodiment, the shaft 26 comprises an outertransverse diameter and the outer transverse diameter is between 1 mmand 3 mm. In one embodiment, the shaft 26 comprises an outer transversediameter and the outer transverse diameter is between 2 mm and 2.2 mm.The spring 28 surrounds the proximal end 38 of the distal portion 32 ofthe pushrod 24, and the spring 28 is between and abuts the distal end 36of the proximal portion 30 of the pushrod 24 and the proximal portion 46of the shaft 26. The user interface 10 further comprises a shaftsecuring pin 50 configured to insert within a recess 52 in the distalhandle 20, thereby securing the shaft 26 from moving relative to thedistal handle 20.

According to another embodiment of the present invention, there isprovided a working end for performing a function during minimallyinvasive surgery, where the working end is configured to reversibly matewith the distal end of the distal portion of the user interface. Avariety of working ends performing a variety of functions can beprovided, as will be understood by those with skill in the art withreference to this disclosure, such as for example a function selectedfrom the group consisting of canulating, clip application, cutting,grasping, lighting, recording images, retracting, sealing, suctioning,and viewing images. In one embodiment, the working end is a grasperworking end which performs a grasping and holding function. Referringnow to FIG. 4, FIG. 5, FIG. 6 and FIG. 7, there are shown, respectively,a close-up, partial, lateral perspective view of a grasper working endreversibly attached to the distal end of the user interface with thegrasper working end in the open position (FIG. 4); a close-up, partial,lateral perspective view of a grasper working end reversibly attached tothe distal end of the user interface with the grasper working end in theclosed position (FIG. 5); an exploded, close-up, partial, lateralperspective view of a grasper working end and the distal end of the userinterface as shown in FIG. 4 (FIG. 6); and a cutaway, close-up, partial,lateral perspective view of a grasper working end reversibly attached tothe distal end of the user interface with the grasper working end in theopen position as shown in FIG. 4 taken along the line 7-7 (FIG. 7). Ascan be seen, the grasper working end 100 comprises a head piece 102comprising a proximal portion 104 of the head piece 102 connected to adistal portion 106 of the head piece 102. The grasper working end 100further comprises a jaw pushrod 108 comprising a proximal portion 110 ofthe jaw pushrod 108 and a distal end 112 of the jaw pushrod 108. Thedistal portion 106 of the head piece 102 is connected to the proximalportion 110 of the jaw pushrod 108 by a jaw pin 114. The grasper workingend 100 further comprises a first jaw 116 and a second jaw 118 connectedto the distal end 112 of the jaw pushrod 108 by a jaw pivot 120, wherethe first jaw 116 and the second jaw 118 approximate and separate fromeach other in response to axial movement of the jaw pushrod 108. Thegrasper working end 100 further comprises a shaft clamp 122 and one ormore than one shaft clamp pins 124 for aligning the shaft clamp 122 withthe proximal portion 104 of the head piece 102. The proximal portion 104of the head piece 102 comprises a recess 126 for mating with the distalportion 48 of the shaft 26 and the distal end 112 of the jaw pushrod108, where the distal portion 48 of the shaft 26 and the distal end 112of the jaw pushrod 108 are secured to the head piece 102 by placing theshaft clamp 122 onto the proximal portion 104 of the head piece 102 andsecuring the shaft clamp 122 onto the proximal portion 104 of the headpiece 102 by threading a threaded fastener 128 over both the shaft clamp122 and the proximal portion 104 of the head piece 102.

In another embodiment of the present invention, there is providedanother working end for performing a function during minimally invasivesurgery, where the working end is configured to reversibly mate with thedistal portion 16 of the user interface 10. In this embodiment, theworking end is a cutting working end which performs a cutting function.Referring now to FIG. 8, there is shown a cutaway, close-up, partial,lateral perspective view of a cutting working end according to thepresent invention reversibly attached to the distal end of the userinterface with the cutting working end in the open position. As can beseen, the cutting working end 130 comprises the same elements as thegrasper working end 100, except that the cutting working end 130comprises a first blade 132 and a second blade 134, instead of a firstjaw 116 and the second jaw 118. Like the first jaw 116 and the secondjaw 118, the first blade 132 and the second blade 134 approximate andseparate from each other in response to axial movement of the jawpushrod 108.

According to another embodiment of the present invention, the deviceaccording to the present invention is a suction device for performing asuction function during minimally invasive surgery. Referring now toFIG. 9, FIG. 10, FIG. 11 and FIG. 12, there are shown, respectively, apartial, frontal-lateral perspective view of a suction device accordingto the present invention (FIG. 9); a lateral perspective view of thesuction device as shown in FIG. 9 (FIG. 10); a cross-sectional, lateralperspective view of the suction device as shown in FIG. 9 taken alongthe line 11-11 (FIG. 11); and an exploded, frontal-lateral perspectiveview of the distal end of the suction device shown in FIG. 9 (FIG. 12).As can be seen, the suction device 200 comprises a suction connector 202proximally, a distal suction head 204 distally and a suction shaft 206connecting the suction connector 202 to the suction head 204. Thesuction connector 202 comprises a joining piece 208 comprising aproximal end 210 of the joining piece 208 and a distal end 212 of thejoining piece 208, and further comprises a central cavity 214 within thejoining piece 208 between the proximal end 210 of the joining piece 208and the distal end 212 of the joining piece 208. The suction connector202 further comprises a circlip 216. During use, a source of suction(not shown) such as a suction hose is inserted through the proximal end210 of the joining piece 208 and into central cavity 214. The circlip216 is then clamped onto the joining piece 208 and grips the source ofsuction thereby holding the source of suction in place in the joiningpiece 208 creating continuity between the source of suction and thesuction shaft 206.

The suction shaft 206 comprises a hollow tubular structure comprising aproximal end 218 of the suction shaft 206, a distal end 220 of thesuction shaft 206, an intermediate section 222 of the suction shaft 206connecting the proximal end 218 of the suction shaft 206 to the distalend 220 of the suction shaft 206, an inner surface 224 of the suctionshaft 206, an outer surface 226 of the suction shaft 206, a wall 228 ofthe suction shaft 206 defined between the inner surface 224 of thesuction shaft 206 and the outer surface 226 of the suction shaft 206, acentral lumen 230 of the suction shaft 206 defined by the inner surface224 of the suction shaft 206, an outer transverse diameter defined bythe outer surface 226 of the suction shaft 206 and an inner transversediameter defined by the inner surface 224 of the suction shaft 206. Inone embodiment, the outer transverse diameter of the suction shaft 206is between 1 mm and 3 mm. In another embodiment, the outer transversediameter of the suction shaft 206 is between 2 mm and 2.5 mm. In anotherembodiment, the outer transverse diameter of the suction shaft 206 is2.25 mm. In one embodiment, the inner transverse diameter of the suctionshaft 206 is between 1 mm and 3 mm. In another embodiment, the innertransverse diameter of the suction shaft 206 is between 1.5 mm and 2 mm.In another embodiment, the inner transverse diameter of the suctionshaft 206 is 1.95 mm.

The suction head 204 comprises, from proximal to distal as shownparticularly in FIG. 11 and FIG. 12, a fastener 232, a shaft clamp 234,a shaft clamp o-ring 236, a clamp funnel 238, a clamp funnel o-ring 240and a suction tip 242. When assembled, as shown, the distal end 220 ofthe suction shaft 206 passes within the fastener 232, the shaft clamp234, the shaft clamp o-ring 236, the clamp funnel 238, and the clampfunnel o-ring 240 and is fixed in position, allowing suction from thesource of suction to be delivered to the suction tip 242, and externallytherethrough.

In one embodiment, the suction device 200 further comprises a fine mesh244 covering the suction tip 242 which assists in preventing occlusionof the suction tip by body tissues such as fat and omentum and by bloodclots during use.

In another embodiment of the present invention, there is provided anelectrocautery assembly for performing electrocautery during minimallyinvasive surgery. Referring now to FIG. 13, FIG. 14 and FIG. 15, thereare shown, respectively, a partial, frontal-lateral perspective view ofan electrocautery assembly according to the present invention (FIG. 13);a partial, lateral perspective view of the distal end of theelectrocautery assembly according to the present invention as shown inFIG. 13 (FIG. 14); and a cutaway, partial, lateral perspective view ofthe distal end of the electrocautery assembly according to the presentinvention as shown in FIG. 13 and FIG. 14 taken along the line 15-15(FIG. 15). As can be seen, in one embodiment the electrocautery assembly300 device is an electrocautery device for sealing blood vessels,dissecting tissue, cutting and cauterization. The electrocauteryassembly 300 comprises an electrocautery assembly shaft 302 proximallyconfigured to reversibly mate with an electrocautery assembly head 304distally. The electrocautery assembly shaft 302 comprises a cylindricalstructure comprising a proximal end 306 of the electrocautery assemblyshaft 302, a distal end 308 of the electrocautery assembly shaft 302, anintermediate section 310 of the electrocautery assembly shaft 302connecting the proximal end 306 of the electrocautery assembly shaft 302to the distal end 308 of the electrocautery assembly shaft 302. Theelectrocautery assembly shaft 302 further comprises a central core 312extending from the proximal end 306 of the electrocautery assembly shaft302 to the distal end 308 of the electrocautery assembly shaft 302, andan insulation casing 314 surrounding the central core 312 in theintermediate section 310, where the insulation casing 314 comprises anouter surface 316 of the insulation casing 314. The electrocauteryassembly shaft 302 further comprises an outer transverse diameterdefined by the outer surface 316 of the electrocautery assembly shaft302. The central core 312 comprises material suitable for transmittingan electric charge from the proximal end 306 of the electrocauteryassembly shaft 302 to the distal end 308 of the electrocautery assemblyshaft 302, as will be understood by those with skill in the art withreference to this disclosure. The insulation casing 314 of theelectrocautery assembly shaft 302 comprises material suitable toinsulate any electric charge in the central core 312 from the externalenvironment, as will be understood by those with skill in the art withreference to this disclosure. In one embodiment, the outer transversediameter of the electrocautery assembly shaft 302 is between 1 mm and 3mm. In another embodiment, the outer transverse diameter of theelectrocautery assembly shaft 302 is between 2 mm and 2.5 mm. In anotherembodiment, the outer transverse diameter of the electrocautery assemblyshaft 302 is 2.3 mm.

The electrocautery assembly head 304 comprises a proximal end 318 of theelectrocautery assembly head 304, and a distal end 320 of theelectrocautery assembly head 304, and comprises from the proximal end318 of the electrocautery assembly head 304 to the distal end 320 of theelectrocautery assembly head 304, a proximal section 322 of theelectrocautery assembly head 304 connected to an intermediate section324 of the electrocautery assembly head 304 connected to a distalsection 326 of the electrocautery assembly head 304. The electrocauteryassembly head 304 further comprises an insulation casing 328 of theelectrocautery assembly head 304 and a central core 330 of theelectrocautery assembly head 304, where the insulation casing 328 of theelectrocautery assembly head 304 surrounds the core 330 in the proximalsection 322 of the electrocautery assembly head 304 and the intermediatesection 324 of the electrocautery assembly head 304, and where thedistal section 326 of the electrocautery assembly head 304 comprises thecore 330 of the electrocautery assembly head 304. The proximal section322 of the electrocautery assembly head 304 is a hollow tubularstructure defined by the insulation casing 328 and is configured to matewith the distal end 308 of the electrocautery assembly shaft 302, suchas for example by being threaded onto the distal end 308 of theelectrocautery assembly shaft 302. The distal end 308 of theelectrocautery assembly shaft 302 fits into a matching recess in theintermediate section 324 of the electrocautery assembly head 304 asshown particularly in FIG. 15 thereby making electrical contact with thecore 330 of the electrocautery assembly head 304. The core 330 comprisesmaterial suitable for transmitting an electric charge from the distalend 308 of the electrocautery assembly shaft 302 to the distal end 320of the electrocautery assembly head 304 and therethrough to livingtissue, as will be understood by those with skill in the art withreference to this disclosure. The insulation casing 328 of theelectrocautery assembly head 304 comprises material suitable to insulateany electric charge in the core 330 from the external environment, aswill be understood by those with skill in the art with reference to thisdisclosure.

The proximal end 306 of the electrocautery assembly shaft 302 isconfigured to mate with the distal end of a standard electrocautery unitas used in open minimally invasive surgery often referred to as a“Bovie.” The distal end 308 of the electrocautery assembly shaft 302 isconfigured to mate with the proximal section 322 of the electrocauteryassembly head 304 such as for example by being threaded onto theproximal section 322 of the electrocautery assembly head 304. Electriccurrent from the distal end of a standard electrocautery unit passesthrough the core 312 of the electrocautery assembly shaft 302 and intothe core 330 of the electrocautery assembly head 304 therebytransmitting an electric current from the distal end of anelectrocautery unit to the distal end 308 of the electrocautery assemblyshaft 302 to the distal section 326 of the electrocautery assembly 300and therethrough to living tissue.

According to another embodiment of the present invention, there isprovided a system for performing minimally invasive surgery. The systemcomprises one or more than one device according to the presentinvention. In one embodiment, the system comprises written or recordeddirections for using the one or more than one device. In one embodiment,the system comprises two devices according to the present invention. Inone embodiment, the system comprises a user interface according to thepresent invention and further comprises a working end that mates withthe user interface according to the present invention. In a preferredembodiment, the system is used to perform a method according to thepresent invention which minimizes scarring on the abdominal wall whileproviding for adequate triangulation of the devices from differentangles during the method.

According to another embodiment of the present invention, there isprovided a method for performing a form of minimally invasive surgeryreferred to as “scarless microport augmented restoration oftriangulation surgery” (SMART surgery). In summary, scarless microportaugmented restoration of triangulation surgery comprises making two ormore than two openings, such as a first opening and a second openinginto a body wall, where the body wall separates a body cavity within thebody from a space outside of the body. The first opening has a maximumsize that permits the introduction of a first part of a first devicehaving a maximum external transverse dimension greater than 3 mm intothe body cavity. The second opening has a maximum size that permits theintroduction of a second part of the first device having a maximumexternal transverse dimension between 0.1 mm and 3 mm but no greaterthan 3 mm into the body cavity. The method comprises introducing thesecond part of the first device having a maximum external transversedimension between 0.1 mm and 3 mm through the second opening and intothe body cavity, passing the second part of the first device through thefirst opening into the space outside of the body, coupling the firstpart of the first device to the second part of the first device in thespace outside of the body to make an assembled first device, and passingthe first part of the first device coupled to the second part of thefirst device back into the body cavity through the first opening therebymaking a functional first device within the body cavity. In oneembodiment, a second device is introduced into the body cavity throughthe first opening, and the first device and the second device are thenused to perform a procedure within the body cavity allowing fortriangulation of the first device with respect to the second device. Ina preferred embodiment, the method further comprises making a thirdopening. The third opening has a maximum size that permits theintroduction of a second part of a second device having a maximumexternal transverse dimension between 0.1 mm and 3 mm but no greaterthan 3 mm into the body cavity, and the method further comprisesintroducing the second part of the second device having a maximumexternal transverse dimension between 0.1 mm and 3 mm through the thirdopening and into the body cavity, passing the second part of the seconddevice through the first opening into the space outside of the body,coupling the first part of the second device to the second part of thesecond device in the space outside of the body to make an assembledsecond device, and passing the first part of the second device coupledto the second part of the second device back into the body cavitythrough the first opening thereby making a functional second devicewithin the body cavity. The first device and the second device are thenused to perform a procedure within the body cavity allowing fortriangulation of the first device with respect to the second device. Ina preferred embodiment, the method further comprises introducing a thirddevice through the first opening and into the body cavity, and the firstdevice, second device and third device are then used to perform aprocedure within the body cavity allowing for triangulation of the firstdevice with respect to the second device and with respect to the thirddevice. The method will now be disclosed in additional detail.

According to another embodiment of the present invention, there isprovided a method for performing a form of minimally invasive surgery,referred to as “scarless microport augmented restoration oftriangulation surgery” (SMART surgery), in a body cavity within a livingbody, where the body cavity is separated from a space outside of thebody by a body wall. Referring now to FIG. 16 through FIG. 32 there areshown some steps in a method for performing minimally invasive surgeryaccording to the present invention, where 400 is a body wall (in thiscase an abdominal wall) separating a body cavity 402 from the spaceoutside of the body 404, 406 is a first opening, 408 is a secondopening, 410 is a first port in the first opening, 412 is a second portin the second opening, 414 is the first part of a first device, 416 isthe second part of the first device, 418 is a standard surgical suctionapparatus, 420 is a third opening, 422 is a third port in the thirdopening, 424 is the first part of a second device, 426 is the secondpart of the second device and 428 is the second, first part of the firstdevice to the second part of the first device.

In one embodiment, the body cavity is selected from the group consistingof an abdominal cavity, a pelvic cavity and a thoracic cavity. In oneembodiment, the body wall is selected from the group consisting of anabdominal wall, a colonic wall, an esophageal wall, a thoracic wall, atracheal wall, an oral wall and a vaginal wall. In one embodiment, theliving body is a living human body.

The method comprises providing a first device comprising a first partand a second part, where the first part of the first device has amaximum external transverse dimension greater than 3 mm, and where thesecond part of the first device has a maximum external transversedimension of between 0.1 mm and 3 mm. In one embodiment, the firstdevice is a device according to the present invention. In oneembodiment, the first part of the first device is a working endaccording to the present invention, and the second part of the firstdevice is an intermediate portion of a user interface according to thepresent invention. In one embodiment, the first device is a suctiondevice according to the present invention, and the first part of thefirst device is a suction head, and the second part of the first deviceis a suction shaft. In one embodiment, the first device is anelectrocautery assembly according to the present invention, and thefirst part of the first device is the electrocautery assembly head, andthe second part of the first device is the electrocautery assemblyshaft. In a preferred embodiment, the method further comprises providinga second device. In one embodiment, the second device comprises a firstpart and a second part, where the first part of the second device has amaximum external transverse dimension greater than 3 mm, and where thesecond part of the second device has a maximum external transversedimension of between 0.1 mm and 3 mm. In one embodiment, the seconddevice is a device according to the present invention. In oneembodiment, the first part of the second device is a working endaccording to the present invention, and the second part of the seconddevice is an intermediate portion of a user interface according to thepresent invention. In one embodiment, the second device is a suctiondevice according to the present invention, and the first part of thesecond device is a suction head, and the second part of the seconddevice is a suction shaft. In one embodiment, the second device is anelectrocautery assembly according to the present invention, and thefirst part of the second device is the electrocautery assembly head, andthe second part of the second device is the electrocautery assemblyshaft. In another embodiment, the first device or the second device isselected from the group consisting of a canulator, a clip applied, acutter, a grasper, an image recorder, an image viewer, a retractor, asealer and a suction.

Referring now to the Figures, and in particular FIG. 16 and FIG. 17, themethod comprises making two or more than two openings, such as a firstopening and a second opening into a body wall (in this case an abdominalwall), where the body wall separates a body cavity within the body froma space outside of the body. In one embodiment, the two or more than twoopenings consist of between two openings and fifty openings into thebody wall. In another embodiment, the two or more than two openingsconsist of between two openings and twenty openings into the body wall.In another embodiment, the two or more than two openings consist ofbetween two openings and ten openings into the body wall. In anotherembodiment, the two or more than two openings consist of between twoopenings and five openings into the body wall. In another embodiment,the two or more than two openings consist of four openings into the bodywall. In another embodiment, the two or more than two openings consistof three openings into the body wall. In another embodiment, the two ormore than two openings consist of two openings into the body wall.

The method comprises making a first opening through the body wall andinto the body cavity. In one embodiment, the first opening is made usinga surgical scalpel. In another embodiment, the first opening is madeusing a no-scalpel technique. In another embodiment, the first openingis made using a trocar. In one embodiment, the body wall is an abdominalwall and the first opening is made in an abdominal wall through anumbilicus or through an umbilical crease. The first opening has amaximum transverse dimension that permits introduction of the first partof the first device from the space outside of the body through the firstopening and into the body cavity, where the first part of the firstdevice has a maximum external transverse dimension greater than 3 mm,such as for example where the first part of the first device has amaximum external transverse dimension of between 3 mm and 50 mm. As willbe understood by those with skill in the art with reference to thisdisclosure, the maximum transverse dimension of an opening in the bodywall is measured with respect to the surface of the body wall, not withrespect to the thickness of the body wall. In one embodiment, the methodfurther comprises introducing a first port into the first opening, wherethe first port extends from the space outside of the body through thebody wall and into the body cavity. The first port has a maximumtransverse dimension that permits introduction of the first part of afirst device from a space outside of the body through the first port andinto the body cavity, where the first part of the first device has amaximum external transverse dimension greater than 3 mm, such as forexample where the first part of the first device has a maximum externaltransverse dimension of between 3 mm and 50 mm. As will be understood bythose with skill in the art with reference to this disclosure, themaximum transverse dimension of a port is measured with respect tosurface of the body wall once the port is placed, not with respect tothe thickness of the body wall. In one embodiment, the first part of thefirst device has a maximum external transverse dimension between 3 mmand 50 mm. In another embodiment, the first part of the first device hasa maximum external transverse dimension between 5 mm and 50 mm. Inanother embodiment, the first part of the first device has a maximumexternal transverse dimension between 3 mm and 20 mm. In anotherembodiment, the first part of the first device has a maximum externaltransverse dimension between 3 mm and 12 mm. In another embodiment, thefirst part of the first device has a maximum external transversedimension between 5 mm and 10 mm. In another embodiment, the first partof the first device has a maximum external transverse dimension between20 mm and 30 mm. In one embodiment, the first opening has a maximumtransverse dimension of between 3 mm and 80 mm. In another embodiment,the first opening has a maximum transverse dimension of between 3 mm and50 mm. In another embodiment, the first opening has a maximum transversedimension of between 5 mm and 50 mm. In another embodiment, the firstopening has a maximum transverse dimension of between 3 mm and 20 mm. Inanother embodiment, the first opening has a maximum transverse dimensionof between 3 mm and 12 mm. In another embodiment, the first opening hasa maximum transverse dimension of between 5 mm and 10 mm. In anotherembodiment, the first opening has a maximum transverse dimension ofbetween 20 mm and 30 mm. In one embodiment, the first port has a maximumtransverse dimension of between 3 mm and 80 mm. In another embodiment,the first port has a maximum transverse dimension of between 3 mm and 50mm. In another embodiment, the first port has a maximum transversedimension of between 5 mm and 50 mm. In another embodiment, the firstport has a maximum transverse dimension of between 3 mm and 20 mm. Inanother embodiment, the first port has a maximum transverse dimension ofbetween 3 mm and 12 mm. In another embodiment, the first port has amaximum transverse dimension of between 5 mm and 10 mm. In anotherembodiment, the first port has a maximum transverse dimension of between20 mm and 30 mm. The larger maximum transverse dimensions of the firstopening and first port are used when a large tissue such as an intactkidney is removed through the first opening using the present method, orwhen multiple devices are introduced into the first opening or firstport simultaneously, as will be understood by those with skill in theart with reference to this disclosure.

Then, the method comprises making a second opening through the body walland into the body cavity. In one embodiment, the second opening is madeusing a surgical scalpel. In another embodiment, the first opening ismade using a no-scalpel technique. In another embodiment, the secondopening is made using a trocar. The second opening has a maximumtransverse dimension between 0.1 mm and 3 mm and permits introduction ofa second part of the first device from the space outside of the bodythrough the second opening and into the body cavity. In one embodiment,the method further comprises introducing a second port into the secondopening, where the second port extends from the space outside of thebody through the body wall and into the body cavity, and where thesecond port has a maximum transverse dimension between 0.1 mm and 3 mmthat permits introduction of a second part of the first device from aspace outside of the body through the second opening and into the bodycavity. In one embodiment, the second part of the first device has amaximum external transverse dimension between 0.1 mm and 3 mm. Inanother embodiment, the second part of the first device has a maximumexternal transverse dimension between 1 mm and 3 mm. In anotherembodiment, the second part of the first device has a maximum externaltransverse dimension between 2 mm and 3 mm. In another embodiment, thesecond part of the first device has a maximum external transversedimension of 2.5 mm In one embodiment, the second opening has a maximumtransverse dimension of between 1 mm and 3 mm. In another embodiment,the second opening has a maximum transverse dimension of between 2 mmand 3 mm. In another embodiment, the second opening has a maximumtransverse dimension of 2.5 mm. In one embodiment, the second port has amaximum transverse dimension of between 1 mm and 3 mm. In anotherembodiment, the second port has a maximum transverse dimension ofbetween 2 mm and 3 mm. In another embodiment, the second port has amaximum transverse dimension of 2.5 mm.

In a preferred embodiment, the method further comprises making a thirdopening through the body wall and into the body cavity, as shownparticularly in FIG. 24. In one embodiment, the third opening is madeusing a surgical scalpel. In another embodiment, the first opening ismade using a no-scalpel technique. In another embodiment, the thirdopening is made using a trocar. The third opening has a maximumtransverse dimension between 0.1 mm and 3 mm and permits introduction ofa second part of the second device from the space outside of the bodythrough the third opening and into the body cavity. In one embodiment,the method further comprises introducing a third port into the thirdopening, where the third port extends from the space outside of the bodythrough the body wall and into the body cavity, and where the third porthas a maximum transverse dimension between 0.1 mm and 3 mm that permitsintroduction of a second part of the second device from a space outsideof the body through the third opening and into the body cavity. In oneembodiment, the second part of the second device has a maximum externaltransverse dimension between 0.1 mm and 3 mm. In another embodiment, thesecond part of the second device has a maximum external transversedimension between 1 mm and 3 mm. In another embodiment, the second partof the second device has a maximum external transverse dimension between2 mm and 3 mm. In another embodiment, the second part of the seconddevice has a maximum external transverse dimension of 2.5 mm. In oneembodiment, the third opening has a maximum transverse dimension ofbetween 1 mm and 3 mm. In another embodiment, the third opening has amaximum transverse dimension of between 2 mm and 3 mm. In anotherembodiment, the third opening has a maximum transverse dimension of 2.5mm. In one embodiment, the third port has a maximum transverse dimensionof between 1 mm and 3 mm. In another embodiment, the third port has amaximum transverse dimension of between 2 mm and 3 mm. In anotherembodiment, the third port has a maximum transverse dimension of 2.5 mm.

Next, as can be seen particularly in FIG. 18 through FIG. 22, the methodfurther comprises introducing the second part of the first device fromthe space outside of the body through the second opening (and throughthe second port when present) into the body cavity, passing the secondpart of the first device from inside of the body cavity through thefirst opening (and through the first port when present) into the spaceoutside of the body, coupling the first part of the first device to thesecond part of the first device in the space outside of the body to makean assembled first device, and passing the first part of the firstdevice coupled to the second part of the first device back into the bodycavity through the first opening (and through the first port whenpresent). In one embodiment, as can be seen in

FIG. 23, the method further comprises introducing a second device (suchas a standard surgical suction apparatus shown in FIG. 23) into the bodycavity through the first opening (and through the first port whenpresent), and the first device and the second device are then used toperform a procedure within the body cavity allowing for triangulation ofthe first device with respect to the second device.

In a preferred embodiment, as can be seen particularly in FIG. 14through FIG. 27, the method further comprises providing a second devicecomprising a first part and a second part; making the third openingthrough the body wall and into the body cavity, introducing the secondpart of the second device from the space outside of the body through thethird opening (and through the third port when present) into the bodycavity, passing the second part of the second device from inside of thebody cavity through the first opening (and through the first port whenpresent) into the space outside of the body, coupling the first part ofthe second device to the second part of the second device in the spaceoutside of the body to make an assembled second device, and passing thefirst part of the second device coupled to the second part of the seconddevice back into the body cavity through the first opening (and throughthe first port when present). The first device and the second device arethen used to perform a procedure within the body cavity allowing fortriangulation of the first device with respect to the second device. Ina preferred embodiment, as can be seen particularly in FIG. 28, themethod further comprises introducing a third device (such as a standardsurgical suction apparatus shown in FIG. 28) into the body cavitythrough the first opening (and through the first port when present), andthe first device, the second device and the third device are then usedto perform a procedure within the body cavity allowing for triangulationof the first device with respect to the second device and with respectto the third device.

Next, the method further comprises passing the first part of the firstdevice and second part of the first device from the body cavity backthrough the first opening (and through the first port when present) andinto the space outside of the body, uncoupling and removing the firstpart of the first device from the second part of the first device. Inone embodiment, as can be seen in FIG. 29 through FIG. 31, the methodfurther comprises passing the second part of the first device backthrough the first opening (and through the first port when present) andinto the body cavity, and then back through the second opening (andthrough the second port when present) thereby removing the first part ofthe first device from the body. In another embodiment, the first part ofthe first device is a first, first part of the first device, and themethod further comprises coupling a second, first part of the firstdevice to the second part of the first device in the space outside ofthe body to make a second, first device, passing the second, first partof the first device coupled to the second part of the first device backinto the body cavity through the first opening (and through the firstport when present) and using the second, first device to perform aprocedure within the body cavity. In one embodiment, the method furthercomprises repeating these steps using a third, first part of the firstdevice in place of the second, first part of the first device, as willbe understood by those with skill in the art with reference to thisdisclosure.

In one embodiment, the method comprises using a surgical robot tocontrol one or more than one of the devices. In a preferred embodiment,the surgical robot is a da Vinci® robot available from IntuitiveSurgical, Inc., Sunnyvale, Calif. US. In another preferred embodiment,the surgical robot is a surgical robot available from Hansen Medical,Mountain View, Calif. US. In another preferred embodiment, the surgicalrobot is an integrated endoscopic robotic EndoSAMURAI® available fromOlympus Medical Systems Corporation, Center Valley, Pa. US.

Finally, as can be seen in FIG. 32, the method further comprisesremoving all devices from within the body cavity and removing all ports,and closing any openings greater than 5 mm according to standardtechniques, as will be understood by those with skill in the art withreference to this disclosure. Incisions 5 mm or less generally do notneed to be closed but will seal themselves. Placement of the firstopening in the umbilicus or umbilical crease allows the scar for thefirst opening to be essentially invisible after healing. Use of verysmall 3 mm or less incisions for the remaining openings allows the skinto heal essentially without any visible scaring after healing.

Although the present invention has been discussed in considerable detailwith reference to certain preferred embodiments, other embodiments arepossible. Therefore, the scope of the appended claims should not belimited to the description of preferred embodiments contained in thisdisclosure. All references cited herein are incorporated by reference totheir entirety.

1. A device for use in performing minimally invasive surgery, the devicecomprising a user interface comprising: a) a proximal portion, anintermediate portion and a distal portion, where the intermediateportion connects the proximal portion to the distal portion; and b) apushrod, a shaft and a spring; where the distal portion is configured toreversibly mate with a working end; where the proximal portion isconfigured to allow a user to hold and direct the user interface, and tooperate the working end attached to the distal portion of the userinterface; where the proximal portion of the user interface comprises aproximal handle and a distal handle joined together by and rotatablearound a pivot; where the pushrod comprises a proximal portion of thepushrod and a distal portion of the pushrod; where the proximal portionof the pushrod comprises a proximal end of the proximal portion of thepushrod, and comprises a distal end of the proximal portion of thepushrod; where the proximal end of the proximal portion of the pushrodis linked to the proximal handle, such that movement of the proximalhandle around the pivot translates into axial movement of the pushrod;where the distal portion of the pushrod comprises a proximal end of thedistal portion of the pushrod, and comprises a distal end of the distalportion of the pushrod; where the distal end of the proximal portion ofthe pushrod is joined to the proximal end of the distal portion of thepushrod at a junction; where the distal end of the distal portion of thepushrod comprises an expansion for mating with the working end; wherethe shaft comprises a hollow tubular structure comprising a longitudinalaxis and further comprises a proximal portion of the shaft and a distalportion of the shaft; where the shaft surrounds at least part of thedistal portion of the pushrod; where the distal portion of the pushrodis axially slidable within the shaft; and where the spring surrounds theproximal end of the distal portion of the pushrod, and the spring isbetween and abuts the distal end of the proximal portion of the pushrodand the proximal portion of the shaft. 2-6. (canceled)
 7. A device foruse in performing minimally invasive surgery, the device comprising aworking end for mating with a user interface, the working end having agrasping function, and the working end comprising: a) a head piececomprising a proximal portion of the head piece connected to a distalportion of the head piece; b) a jaw pushrod comprising a proximalportion of the jaw pushrod and a distal end of the jaw pushrod; c) afirst jaw and a second jaw connected to the distal end of the jawpushrod by a jaw pivot; and d) a shaft clamp and one or more than oneshaft clamp pins for aligning the shaft clamp with the proximal portionof the head piece; where the distal portion of the head piece isconnected to the proximal portion of the jaw pushrod by a jaw pin; wherethe first jaw and the second jaw approximate and separate from eachother in response to axial movement of the jaw pushrod; where theproximal portion of the head piece comprises a recess for mating withthe distal portion of the shaft and the distal end of the jaw pushrod;and where the distal portion of the shaft and the distal end of the jawpushrod are secured to the head piece by placing the shaft clamp ontothe proximal portion of the head piece and securing the shaft clamp ontothe proximal portion of the head piece by threading a threaded fastenerover both the shaft clamp and the proximal portion of the head piece. 8.A device for use in performing minimally invasive surgery, the devicecomprising a working end for mating with a user interface, the workingend having a cutting function, and the working end comprising: a) a headpiece comprising a proximal portion of the head piece connected to adistal portion of the head piece; b) a blade pushrod comprising aproximal portion of the blade pushrod and a distal end of the bladepushrod; c) a first blade and a second blade connected to the distal endof the blade pushrod by a blade pivot; and d) a shaft clamp and one ormore than one shaft clamp pins for aligning the shaft clamp with theproximal portion of the head piece; where the distal portion of the headpiece is connected to the proximal portion of the blade pushrod by ablade pin; where the first blade and the second blade approximate andseparate from each other in response to axial movement of the bladepushrod; where the proximal portion of the head piece comprises a recessfor mating with the distal portion of the shaft and the distal end ofthe blade pushrod; and where the distal portion of the shaft and thedistal end of the blade pushrod are secured to the head piece by placingthe shaft clamp onto the proximal portion of the head piece and securingthe shaft clamp onto the proximal portion of the head piece by threadinga threaded fastener over both the shaft clamp and the proximal portionof the head piece.
 9. A device for performing a suction function duringminimally invasive surgery, the device comprising a suction connectorproximally, a suction head distally and a suction shaft connecting thesuction connector to the suction head; where the suction connectorcomprises a joining piece comprising a proximal end of the joining pieceand a distal end of the joining piece, and further comprises a centralcavity within the joining piece between the proximal end of the joiningpiece and the distal end of the joining piece; where the suctionconnector further comprises a circlip for clamping a source of suctioninserted through the proximal end of the joining piece and into centralcavity onto the joining piece; where the suction shaft comprises ahollow tubular structure comprising a proximal end of the suction shaft,a distal end of the suction shaft, an intermediate section of thesuction shaft connecting the proximal end of the suction shaft to thedistal end of the suction shaft, an inner surface of the suction shaft,an outer surface of the suction shaft, a wall of the suction shaftdefined between the inner surface of the suction shaft and the outersurface of the suction shaft, a central lumen of the suction shaftdefined by the inner surface of the suction shaft, an outer transversediameter defined by the outer surface of the suction shaft and an innertransverse diameter defined by the inner surface of the suction shaft;where the suction head comprises from proximal to distal a fastener, ashaft clamp, a shaft clamp o-ring, a clamp funnel, a clamp funnel o-ringand a suction tip; where the distal end of the suction shaft passeswithin the fastener, the shaft clamp, the shaft clamp o-ring, the clampfunnel, and the clamp funnel o-ring and is fixed in position, allowingsuction from a source of suction to be delivered to the suction tip, andexternally there through; and where the outer transverse diameter of thesuction shaft is between 1 mm and 3 mm 10-15. (canceled)
 16. A devicefor performing minimally invasive surgery, where the device is anelectrocautery assembly for performing electrocautery, theelectrocautery assembly comprising: a) an electrocautery assembly shaftproximally configured to reversibly mate with an electrocautery assemblyhead distally; where the electrocautery assembly shaft comprises acylindrical structure comprising a proximal end of the electrocauteryassembly shaft, a distal end of the electrocautery assembly shaft, anintermediate section of the electrocautery assembly shaft connecting theproximal end of the electrocautery assembly shaft to the distal end ofthe electrocautery assembly shaft; and b) a central core extending fromthe proximal end of the electrocautery assembly shaft to the distal endof the electrocautery assembly shaft and an insulation casingsurrounding the central core in the intermediate section, where theinsulation casing comprises an outer surface of the insulation casing;where the electrocautery assembly shaft further comprises an outertransverse diameter defined by the outer surface of the electrocauteryassembly shaft; where the central core comprises material suitable fortransmitting an electric charge from the proximal end of theelectrocautery assembly shaft to the distal end of the electrocauteryassembly shaft; where the insulation casing of the electrocauteryassembly shaft comprises material suitable to insulate any electriccharge in the central core from the external environment; where theelectrocautery assembly head comprises a proximal end of theelectrocautery assembly head, and a distal end of the electrocauteryassembly head, and comprises from the proximal end of the electrocauteryassembly head to the distal end of the electrocautery assembly head, aproximal section of the electrocautery assembly head connected to anintermediate section of the electrocautery assembly head connected to adistal section of the electrocautery assembly head; where theelectrocautery assembly head further comprises an insulation casing ofthe electrocautery assembly head and a central core of theelectrocautery assembly head; where the insulation casing of theelectrocautery assembly head surrounds the core in the proximal sectionof the electrocautery assembly head and the intermediate section of theelectrocautery assembly head; where the distal section of theelectrocautery assembly head comprises the core of the electrocauteryassembly head; where the proximal section of the electrocautery assemblyhead is a hollow tubular structure defined by the insulation casing andis configured to mate with the distal end of the electrocautery assemblyshaft; where the distal end of the electrocautery assembly shaft fitsinto a matching recess in the intermediate section of the electrocauteryassembly head, thereby making electrical contact with the core of theelectrocautery assembly head; where the core comprises material suitablefor transmitting an electric charge from the distal end of theelectrocautery assembly shaft to the distal end of the electrocauteryassembly head, and there through to living tissue; where the insulationcasing of the electrocautery assembly head comprises material suitableto insulate any electric charge in the core from the externalenvironment; where the distal end of the electrocautery assembly shaftis configured to mate with the proximal section of the electrocauteryassembly head; and where the outer transverse diameter of theelectrocautery assembly shaft is between 1 mm and 3 mm. 17-21.(canceled)
 22. A method for performing a form of minimally invasivesurgery, referred to as “scarless microport augmented restoration oftriangulation surgery” (SMART surgery), in a body cavity within a livingbody, where the body cavity is separated from a space outside of thebody by a body wall, the method comprising: a) providing a first devicecomprising a first part and a second part; b) making two or more thantwo openings into the body wall, where the two or more than two openingscomprise a first opening and a second opening; where the first openinghas a maximum transverse dimension that permits introduction of thefirst part of the first device from the space outside of the bodythrough the first opening and into the body cavity, where the first partof the first device has a maximum external transverse dimension greaterthan 3 mm; where the second opening has a maximum transverse dimensionbetween 0.1 mm and 3 mm and permits introduction of a second part of thefirst device from the space outside of the body through the secondopening and into the body cavity, where the second part of the firstdevice has a maximum external transverse dimension of between 0.1 mm and3 mm; c) introducing the second part of the first device from the spaceoutside of the body through the second opening into the body cavity; d)passing the second part of the first device from inside of the bodycavity through the first opening into the space outside of the body; e)coupling the first part of the first device to the second part of thefirst device in the space outside of the body to make an assembled firstdevice; f) passing the first part of the first device coupled to thesecond part of the first device back into the body cavity through thefirst opening; and g) using the first device to perform a procedurewithin the body cavity.
 23. The method of claim 22, further comprising:a) introducing a second device into the body cavity through the firstopening; and b) using the first device and the second device to performa procedure within the body cavity allowing for triangulation of thefirst device with respect to the second device.
 24. The method of claim22, further comprising: a) providing a second device comprising a firstpart and a second part; b) making a third opening through the body walland into the body cavity, and where the third opening has a maximumtransverse dimension between 0.1 mm and 3 mm and permits introduction ofthe second part of the second device from the space outside of the bodythrough the third opening and into the body cavity; c) introducing thesecond part of the second device from the space outside of the bodythrough the third opening into the body cavity; d) passing the secondpart of the second device from inside of the body cavity through thefirst opening into the space outside of the body; e) coupling the firstpart of the second device to the second part of the second device in thespace outside of the body to make an assembled second device; f) passingthe first part of the second device coupled to the second part of thesecond device back into the body cavity through the first opening; andg) using the second device to perform a procedure within the bodycavity.
 25. The method of claim 24, further comprising: a) introducing athird device into the body cavity through the first opening; and b)using the first device, the second device and the third device toperform a procedure within the body cavity allowing for triangulation ofthe first device with respect to the second device and with respect tothe third device.
 26. The method of claim 22, where the body cavity isselected from the group consisting of an abdominal cavity, a pelviccavity and a thoracic cavity.
 27. The method of claim 22, where the bodywall is selected from the group consisting of an abdominal wall, acolonic wall, an esophageal wall, a thoracic wall, a tracheal wall, anoral wall and a vaginal wall.
 28. The method of claim 22, where theliving body is a living human body.
 29. The method of claim 22, wherethe two or more than two openings consist of between two openings andfifty openings into the body wall.
 30. The method of claim 22, where thetwo or more than two openings consist of between two openings and twentyopenings into the body wall.
 31. The method of claim 22, where the twoor more than two openings consist of between two openings and tenopenings into the body wall.
 32. The method of claim 22, where the twoor more than two openings consist of between two openings and fiveopenings into the body wall.
 33. The method of claim 22, where the twoor more than two openings consist of four openings into the body wall.34. The method of claim 22, where the two or more than two openingsconsist of three openings into the body wall.
 35. The method of claim22, where the two or more than two openings consist of two openings intothe body wall.
 36. The method of claim 22, further comprisingintroducing a first port into the first opening, where the first portextends from the space outside of the body through the body wall andinto the body cavity, where the first port has a maximum transversedimension that permits introduction of the first part of a first devicefrom a space outside of the body through the first port and into thebody cavity, and where the first part of the first device has a maximumexternal transverse dimension greater than 3 mm.
 37. The method of claim22, further comprising introducing a second port into the secondopening, where the second port extends from the space outside of thebody through the body wall and into the body cavity, and where thesecond port has a maximum transverse dimension between 0.1 mm and 3 mmthat permits introduction of a second part of the first device from aspace outside of the body through the second opening and into the bodycavity.
 38. The method of claim 24, further comprising introducing athird port into the third opening, where the third port extends from thespace outside of the body through the body wall and into the bodycavity, and where the third port has a maximum transverse dimensionbetween 0.1 mm and 3 mm that permits introduction of a second part ofthe second device from a space outside of the body through the thirdopening and into the body cavity.
 39. The method of claim 22, furthercomprising passing the first part of the first device and second part ofthe first device from the body cavity back through the first opening andinto the space outside of the body, uncoupling and removing the firstpart of the first device from the second part of the first device. 40.The method of claim 39, further comprising passing the second part ofthe first device back through the first opening and into the bodycavity, and then back through the second opening thereby removing thefirst part of the first device from the body.
 41. The method of claim39, where the first part of the first device is a first, first part ofthe first device, and where the method further comprises coupling asecond, first part of the first device to the second part of the firstdevice in the space outside of the body to make a second, first device,passing the second, first part of the first device coupled to the secondpart of the first device back into the body cavity through the firstopening and using the second, first device to perform a procedure withinthe body cavity.
 42. The method of claim 22, where the method comprisesusing a surgical robot to control the first device.
 43. The method ofclaim 22, further comprising removing all devices from within the bodycavity and removing all ports, and closing any openings greater than 5mm
 44. The method of claim 22, where the first part of the first deviceis a working end and the second part of the first device is anintermediate portion of a user interface.
 45. The method of claim 22,where the first device is a suction, and the first part of the firstdevice is a suction head, and the second part of the first device is asuction shaft.
 46. The method of claim 22, where the first device is anelectrocautery assembly, and the first part of the first device is theelectrocautery assembly head, and the second part of the first device isthe electrocautery assembly shaft.
 47. The method of claim 22, where thefirst device or the second device is selected from the group consistingof a canulator, a clip applied, a cutter, a grasper, an image recorder,an image viewer, a retractor, a sealer and a suction.
 48. The method ofclaim 22, where the first opening is made using a surgical scalpel, ano-scalpel technique or a trocar.
 49. The method of claim 22, where thebody wall is an abdominal wall and the first opening is made through anumbilicus or through an umbilical crease.
 50. The method of claim 22,where the second opening is made using a surgical scalpel, a no-scalpeltechnique or a trocar.
 51. The method of claim 24, where the thirdopening is made using a surgical scalpel, a no-scalpel technique or atrocar.
 52. The method of claim 22, where the first opening has amaximum transverse dimension of between 3 mm and 80 mm.
 53. The methodof claim 22, where the first opening has a maximum transverse dimensionof between 3 mm and 50 mm.
 54. The method of claim 22, where the firstopening has a maximum transverse dimension of between 5 mm and 50 mm.55. The method of claim 22, where the first opening has a maximumtransverse dimension of between 3 mm and 20 mm.
 56. The method of claim22, where the first opening has a maximum transverse dimension ofbetween 3 mm and 12 mm.
 57. The method of claim 22, where the firstopening has a maximum transverse dimension of between 5 mm and 10 mm.58. The method of claim 22, where the first opening has a maximumtransverse dimension of between 20 mm and 30 mm.
 59. The method of claim22, where the second opening has a maximum transverse dimension ofbetween 1 mm and 3 mm.
 60. The method of claim 22, where the secondopening has a maximum transverse dimension of between 2 mm and 3 mm. 61.The method of claim 22, where the second opening has a maximumtransverse dimension of 2.5 mm.
 62. The method of claim 24, where thethird opening has a maximum transverse dimension of between 1 mm and 3mm.
 63. The method of claim 24, where the third opening has a maximumtransverse dimension of between 2 mm and 3 mm.
 64. The method of claim24, where the third opening has a maximum transverse dimension of 2.5mm.
 65. The method of claim 22, where the first part of the first devicehas a maximum external transverse dimension of between 3 mm and 50 mm.66. The method of claim 22, where the first part of the first device hasa maximum external transverse dimension of between 3 mm and 50 mm. 67.The method of claim 22, where the first part of the first device has amaximum external transverse dimension of between 5 mm and 50 mm.
 68. Themethod of claim 22, where the first part of the first device has amaximum external transverse dimension of between 3 mm and 20 mm.
 69. Themethod of claim 22, where the first part of the first device has amaximum external transverse dimension of between 3 mm and 12 mm.
 70. Themethod of claim 22, where the first part of the first device has amaximum external transverse dimension of between 5 mm and 10 mm.
 71. Themethod of claim 22, where the first part of the first device has amaximum external transverse dimension of between 20 mm and 30 mm. 72.The method of claim 22, where the second part of the first device has amaximum external transverse dimension between 0.1 mm and 3 mm.
 73. Themethod of claim 22, where the second part of the first device has amaximum external transverse dimension between 1 mm and 3 mm.
 74. Themethod of claim 22, where the second part of the first device has amaximum external transverse dimension between 2 mm and 3 mm.
 75. Themethod of claim 22, where the second part of the first device has amaximum external transverse dimension of 2.5 mm.
 76. The method of claim22, where the second part of the second device has a maximum externaltransverse dimension between 0.1 mm and 3 mm.
 77. The method of claim22, where the second part of the second device has a maximum externaltransverse dimension between 1 mm and 3 mm.
 78. The method of claim 22,where the second part of the second device has a maximum externaltransverse dimension between 2 mm and 3 mm.
 79. The method of claim 22,where the second part of the second device has a maximum externaltransverse dimension of 2.5 mm.
 80. The method of claim 36, where thefirst port has a maximum transverse dimension of between 3 mm and 80 mm.81. The method of claim 36, where the first port has a maximumtransverse dimension of between 3 mm and 50 mm.
 82. The method of claim36, where the first port has a maximum transverse dimension of between 5mm and 50 mm.
 83. The method of claim 36, where the first port has amaximum transverse dimension of between 3 mm and 20 mm.
 84. The methodof claim 36, where the first port has a maximum transverse dimension ofbetween 3 mm and 12 mm.
 85. The method of claim 36, where the first porthas a maximum transverse dimension of between 5 mm and 10 mm.
 86. Themethod of claim 36, where the first port has a maximum transversedimension of between 20 mm and 30 mm.
 87. The method of claim 37, wherethe second port has a maximum transverse dimension of between 1 mm and 3mm.
 88. The method of claim 37, where the second port has a maximumtransverse dimension of between 2 mm and 3 mm.
 89. The method of claim37, where the second port has a maximum transverse dimension of 2.5 mm.90. The method of claim 38, where the third port has a maximumtransverse dimension of between 1 mm and 3 mm.
 91. The method of claim38, where the third port has a maximum transverse dimension of between 2mm and 3 mm.
 92. The method of claim 38, where the third port has amaximum transverse dimension of 2.5 mm.